|
REVISE GRAFT W/VEIN
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 35881
|
| Hospital Charge Code |
76102910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.37 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna Commercial |
$1,816.68
|
| Rate for Payer: Anthem Medicaid |
$798.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,513.00
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cigna Commercial |
$1,756.98
|
| Rate for Payer: Healthspan PPO |
$1,786.16
|
| Rate for Payer: Humana Medicaid |
$798.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$814.34
|
| Rate for Payer: Molina Healthcare Passport |
$798.37
|
| Rate for Payer: Multiplan PHCS |
$1,507.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,759.10
|
| Rate for Payer: UHCCP Medicaid |
$879.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$806.35
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$940.53
|
| Rate for Payer: Anthem Medicaid |
$400.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,041.98
|
| Rate for Payer: Healthspan PPO |
$851.92
|
| Rate for Payer: Humana Medicaid |
$400.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.12
|
| Rate for Payer: Molina Healthcare Passport |
$400.12
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.12
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REVISE/IMPLANT FINGER JOINT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
761P0714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$940.53
|
| Rate for Payer: Anthem Medicaid |
$400.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,041.98
|
| Rate for Payer: Healthspan PPO |
$851.92
|
| Rate for Payer: Humana Medicaid |
$400.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.12
|
| Rate for Payer: Molina Healthcare Passport |
$400.12
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.12
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$893.50
|
| Rate for Payer: Anthem Medicaid |
$427.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$984.93
|
| Rate for Payer: Healthspan PPO |
$809.32
|
| Rate for Payer: Humana Medicaid |
$427.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.02
|
| Rate for Payer: Molina Healthcare Passport |
$427.47
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.74
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REVISE KNUCKLE WITH IMPLANT(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
761P0713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$893.50
|
| Rate for Payer: Anthem Medicaid |
$427.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$984.93
|
| Rate for Payer: Healthspan PPO |
$809.32
|
| Rate for Payer: Humana Medicaid |
$427.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.02
|
| Rate for Payer: Molina Healthcare Passport |
$427.47
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.74
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Facility
|
OP
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$22,561.84 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem Medicaid |
$1,487.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,115.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,561.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,756.06
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Humana KY Medicaid |
$1,487.37
|
| Rate for Payer: Humana Medicare Advantage |
$16,115.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,502.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,338.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.75
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Professional
|
Both
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,420.54 |
| Max. Negotiated Rate |
$4,325.00 |
| Rate for Payer: Anthem Medicaid |
$1,420.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,325.00
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,417.13
|
| Rate for Payer: Healthspan PPO |
$1,893.35
|
| Rate for Payer: Humana Medicaid |
$1,420.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,292.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,448.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,420.54
|
| Rate for Payer: Multiplan PHCS |
$2,595.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,027.50
|
| Rate for Payer: UHCCP Medicaid |
$1,513.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,434.75
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Facility
|
IP
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$4,152.00 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.75
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Professional
|
Both
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.75 |
| Max. Negotiated Rate |
$3,425.00 |
| Rate for Payer: Anthem Medicaid |
$1,232.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,425.00
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,964.42
|
| Rate for Payer: Healthspan PPO |
$1,641.69
|
| Rate for Payer: Humana Medicaid |
$1,232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,256.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,232.05
|
| Rate for Payer: Multiplan PHCS |
$2,055.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,397.50
|
| Rate for Payer: UHCCP Medicaid |
$1,198.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,244.37
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
REVIS ELBOW ARTH HUM&ULNA(P
|
Professional
|
Both
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
761P0529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,420.54 |
| Max. Negotiated Rate |
$4,325.00 |
| Rate for Payer: Anthem Medicaid |
$1,420.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,325.00
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,417.13
|
| Rate for Payer: Healthspan PPO |
$1,893.35
|
| Rate for Payer: Humana Medicaid |
$1,420.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,292.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,448.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,420.54
|
| Rate for Payer: Multiplan PHCS |
$2,595.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,027.50
|
| Rate for Payer: UHCCP Medicaid |
$1,513.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,434.75
|
|
|
REVIS ELBOW ARTH HUM/ULNA (P
|
Professional
|
Both
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
761P0528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.75 |
| Max. Negotiated Rate |
$3,425.00 |
| Rate for Payer: Anthem Medicaid |
$1,232.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,425.00
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,964.42
|
| Rate for Payer: Healthspan PPO |
$1,641.69
|
| Rate for Payer: Humana Medicaid |
$1,232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,256.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,232.05
|
| Rate for Payer: Multiplan PHCS |
$2,055.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,397.50
|
| Rate for Payer: UHCCP Medicaid |
$1,198.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,244.37
|
|
|
REVISE LOWER LEG TENDON
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.55 |
| Max. Negotiated Rate |
$1,563.00 |
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Anthem Medicaid |
$439.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,563.00
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,006.51
|
| Rate for Payer: Healthspan PPO |
$855.80
|
| Rate for Payer: Humana Medicaid |
$439.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.34
|
| Rate for Payer: Molina Healthcare Passport |
$439.55
|
| Rate for Payer: Multiplan PHCS |
$937.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,094.10
|
| Rate for Payer: UHCCP Medicaid |
$547.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$443.95
|
|
|
REVISE LOWER LEG TENDON
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 27691
|
| Hospital Charge Code |
76102682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$1,190.57 |
| Rate for Payer: Aetna Commercial |
$1,110.52
|
| Rate for Payer: Anthem Medicaid |
$512.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,190.57
|
| Rate for Payer: Healthspan PPO |
$1,005.89
|
| Rate for Payer: Humana Medicaid |
$512.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.20
|
| Rate for Payer: Molina Healthcare Passport |
$512.94
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$661.50
|
| Rate for Payer: UHCCP Medicaid |
$330.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.07
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.19 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem Medicaid |
$537.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Humana KY Medicaid |
$537.52
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$542.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.53
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.19 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.53
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
76102434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Humana KY Medicaid |
$1,281.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
76102434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.98 |
| Max. Negotiated Rate |
$3,725.00 |
| Rate for Payer: Aetna Commercial |
$1,487.59
|
| Rate for Payer: Anthem Medicaid |
$827.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$1,460.40
|
| Rate for Payer: Healthspan PPO |
$1,319.56
|
| Rate for Payer: Humana Medicaid |
$827.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,331.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.54
|
| Rate for Payer: Molina Healthcare Passport |
$827.98
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,607.50
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$836.26
|
|
